Labor and Delivery

When we were packing our bag for the hospital, we had a serious debate that is pretty funny in retrospect: we had read somewhere that we should bring a book in case things got really slow, so we probably spent several days, on and off, trying to figure out whether we should bring Pride and Prejudice or The Adventures of Sherlock Holmes. The idea was that I would read one of them aloud to Brooke while she labored, so keep her calm and keep us alert and focused.

Soon after we got into Labor and Delivery, I got out Pride and Prejudice (the final verdict) and started reading its first chapter. Soon after that, the nurses hooked Brooke up to the IV and started giving her her first dose of Pitocin, along with a continuing flow of antibiotics (because of the Group B strep). We got about one and a half chapters into to Jane Austen. I remember chuckling at the characterization of Mr. and Mrs. Bennett, and also noticing that Brooke wasn’t really laughing.

Luckily I had already read Pride and Prejudice, because 1.5 chapters is all that happened. Soon after that, the Pitocin started dictating the agenda, in a pretty serious way. Brooke had, over the previous hours, had contractions. We had been told they were “mild,” or not real somehow. They felt real enough to her, but the fact was, they were manageable. If we were in a conversation with someone, she’d have to lightly tap me on the arm to let me know to restart my timer.

Just a few minutes after the Pitocin started in through her arm, that all changed. I no longer received a gentle tap on the arm; instead, Brooke convulsed in pain, her eyes rolled back in her head, and she could not speak or do anything other than moan until it was done, usually around 15-20 seconds each.

Before the Pitocin started, Brooke had already been hooked up to a monitor for a few hours (both upstairs in triage and down here in Labor and Delivery). I was nervous (obviously) and one thing I do when I’m nervous is obsessively collect information. Some people, when they get nervous, start yelling, or become violent, or drink, or all of the above. Me, I learn, deduce, hypothesize, conjecture. While Brooke was hooked up to this machine, I therefore had a clear outlet for my nervousness. I watched it measure Brooke’s heartbeat, her blood pressure, the baby’s heartbeat, and something mysterious called “TACO.” This machine also emitted a continuous throbbing beep like on a hospital TV drama, and also a slowly unspooling ticker tape copy of all four measurements. Sometimes the paper would jam, but no one seemed to care. The blood pressure arm-wrap was sitting on the table to which the monitor itself was attached, and about every 5 minutes, it would try and fail to measure Brooke’s blood pressure. I wanted very badly to disconnect it, because every time it failed, it would make an inflation and deflation noise, and also start beeping to let someone know it had failed (a different beep). Also, at some point, the battery got low, and it kept emitting a still different battery-low beep for what felt like 4 hours. I didn’t feel like I had the authority to either (a) plug the machine into the wall to stop the battery alarm or (b) remove the blood pressure arm-wrap since they weren’t using it, and so every time they beeped, I thought about how I wanted to pull them out, and then every time I convinced myself not to. When the nurse finally came in and was like “oh, the battery must be low, I’ll just plug this in!” on the one hand, I was grateful, but on the other, I was pretty frustrated that the dynamic of the situation had made me wait it out until then.

At some point I furtively googled “TACO” on my phone, because I had figured out that it had something to do with the contraction intensity, and I also knew that the contraction intensity is what, prior to Pitocin anyway, wasn’t going right. Or at least to Anna it wasn’t right. “Regular healthy contractions” weren’t happening. I watched the TACO number and conjectured about it. It seems to me it was between 20-30. I didn’t even know what the units were. I knew the heartbeats were both in beats per minute, and the blood pressure, well, I still don’t know what the numbers are, but I know 120/80 is good. But TACO – what was it? Like I said, I furtively googled it, because I didn’t want Brooke to be discouraged by it or even know what it was, since as our joke goes, “a watched pot never boils” is an aphorism Brooke just doesn’t believe.

Now that I think about it, here was another job – worrying about alarms, deadlines, dates – that I usually let Brooke handle, and now here I was taking it on. What I was able to read about TACO was that it had something to do with the intrauterine pressure. I kept trying to figure out what it stood for or what the units were, but I couldn’t find either, at least not while keeping my search secret. I eventually found a discouraging, if out of context fact: wedmd.com suggested that typically a TACO of over 100 was thought necessary to bring about the delivery of a baby. And here Brooke was at 20. Sometimes it even dipped well below that, or went flat entirely. When the contractions came, it spiked a bit, maybe to 40 or 50, but that was it. I didn’t tell her about it, just kept it in. I wasn’t even sure what I read was even relevant; in fact I tried to convince myself it wasn’t.

Because the really big fear we were both contending with was “failure to progress.” Those are the magic words that get a woman in delivery wheeled into the operating room, for the performance of a Caesarian section. Again, I do not think it’s a coincidence that Orwell’s argument in “Politics and the English Language” applies directly to these phrases: “failure to progress,” “operating room,” “general anesthesia,” “Cesarean Section.” All but “to” and “room” are precisely the kinds of Greco-Latinate blurs-of-syllables that disguise either lack of meaning, on the one hand, or outright violence on the other. Imagine if, instead of “due to failure to progress, you will be brought to the operating room where a Cesarean Section procedure will be performed upon you, after you have been placed under general anesthesia,” the doctor said, in good old Anglo-Saxon English, what these words really signify: “this baby is taking too long to come out; we’re going to knock you out and cut it right out of your body while you’re under, then we’re going to wake you up when it’s done and you’ll be a mom!” Shakespeare’s Macduff, Anglo-Saxon to the core, gets it right in Macbeth – “from his mother’s womb untimely ripped.” Martin Luther King talks about the “anesthetizing panes of stained glass” that enclose a modern apolitical church; the anesthesia in this case, though obviously necessary given the operation, is itself also metaphorical. I’m not denying that there’s a time and a place for C-sections, but the obfuscatory title allows that time and place to seem more reasonable and common, the “procedure” more “routine.”

When they started the Pitocin, they asked us what our “pain relief plan” was. A bit less Orwellian, but still on the spectrum. We told them we were hoping for a natural birth, but we were willing to play it by ear, we had never done this, and weren’t totally opposed to adjustments if they seemed necessary. That’s what we said. In Brooke’s mind though, I think she was more like what even our Bradley Method book had said was “unrealistic” – “no anesthesia wanted even with a C-section.”

I will say this for the midwife (now a new shift had started, and the new one’s name as Joy): she was totally willing to hear this. She offered no argument. At some point one of the assisting nurses, Lisa (her shift ended soon after we got to Labor and Delivery) looked at Brooke and said “I have three kids, and I had three epidurals, but I totally respect what you’re doing.” But that was literally the most pressure we got the whole time. Once Joy saw how we thought, she only asked one other time (about which more later). And the new assistant nurse, Lucia, typing whose name makes me choke up, she barely even spoke three words to us the whole time. I think her first language was Spanish. At any rate she was right with us, could not have been more focused and caring, but she was quiet. She spent long stretches of time just sitting just inside the door, on a rolling stool, making sure everything was ok.

Sometime around 6:00, my sister started texting me, offering to come by to visit. Sort of like the proverbial general who believes that a battle will be over and done before dinner, Abby offered to wait until we were ready to eat (i.e., until the baby was born). I tried my best in my agitated state to explain to her that this was nowhere near done. Very sweetly she offered to wait. Again I tried to convey to her that she was making a category error, was missing an order of magnitude. She finally relented and offered to just stop in and say hello. Brooke, though, didn’t want that. She was feeling very private and modest, not wanting Abby or anyone else in my family to see her like this. So we settled on Abby bringing me food (Brooke was now not allowed to eat). I slipped away for a few minutes and talked with Abby, and wolfed down a cheeseburger (the first of like 6 over the next 2 days), and got back into our room, since Brooke was really scared about me not being there. Abby was so kind about it though; she just spent a few minutes and then left a little while later.

I know for sure that at 7:00, our doula arrived. Well, that makes it sound a bit more organized than it was.

Back up 3 weeks, and 5 weeks, and 7, etc., to a recurring conversation between Brooke and me:

“Should we arrange for a doula?”

“Well, I mean with our classes, aren’t we, like, do we need that?”

“And it costs like $1500.”

“Well, let’s keep thinking about it…”

The baby being 3 weeks early, we never got around to it.

Fast forward to about 6:30, probably soon after Abby left. Anna (she was on her way out, but did this for us) asked us if we had a doula. We told her we didn’t. She said there was a volunteer doula service and asked if she wanted us to call it. At this point we were scared shitless in spite of all our training, so we both nodded yes, vigorously, so as not to convey and ambivalence about her making such a call.

Around 7, Noelle walked in. We had never met her before, and haven’t spoken to her since (except for a very kind followup phone call she made about 24 hours later). She seemed friendly, and my flaky-liberal detector actually came up negative. She had this vibe about her that said, maybe, “independent theater company,” which, granted, is somewhere on the flakiness scale. But in this instance, not that far. And how flaky could she be if she was here, with no prior notice, to help two people who were disorganized enough not to have paid for her services?

Things were still relatively slow when she got there: Brooke was in pain every few minutes, but she was fairly lucid during this time. Noelle asked us some questions about ourselves, and we started telling stories about trips we’d taken through England (she had done the same thing recently, maybe, I don’t quite remember).

She started telling us why she was a doula. She said it was this “like feminist thing” (apologetic tone) after she had seen The Business of Being Born. We hadn’t seen it at that time, but a lot of the political digressions I’ve forced on you are paraphrases of that movie. She said it was “like the Food Inc. of childbirth.” Which is both a pretty succinct summary and also a hint as to just how depressing and frightening both are (it also showed us that Noelle was a clued-in individual), though also an excellent recommendation for someone like me, who wants to be reassured about just how terrible everything really is, “centrists’” inane opinions to the contrary.

I don’t believe in supernatural phenomena, I really don’t. I never have, and likely never will if I’ve gotten that far. But one time in my life I’ve come closest to so believing was with Noelle’s being with us through the next twelve hours. Again, the language embarrasses me even to type, but if that’s what angels are, I might now believe in their possibility. Asking nothing of us, Noelle stayed there, hour upon hour, helping Brooke, helping me, letting me take a nap, giving me a snack she had brought with, telling stories that had nothing to do with what was going on but kept us in reasonable spirits, walking Brooke through stretches and massage techniques, helping me imitate both of those, discussing medical options with us.

In one particularly tender moment I remember telling her that I felt so useless. That I thought I’d have more to do, but I thought all I was really doing was giving Brooke a hand to squeeze, and there was nothing else for me, and it was an awful feeling. She just told me it would be okay, and I was doing everything I could do and Brooke appreciated it.

The next 10.5 hours passed very strangely. I wouldn’t say it felt like a long stretch of time or a short one. I do remember there were times I’d look at the clock and realize 2 hours had elapsed since I last looked at it, even though all that had happened was Brooke struggling through the most repetitively painful of processes you can imagine. Sometimes I’d look up and NO time would have elapsed when it felt like a enormous stretch much have passed.

Things grew more and more intense. At some point, Brooke began to curse the Pitocin itself, like a character in a Greek tragedy might bemoan Fate or one of the gods. She was actually making full-on “apostrophes to Pitocin,” personifying it, yelling at it to stop, begging us to tell the nurses to stop it… It grew less and less coherent, and Brooke really did become more and more animalistic in her reaction to events. Words changed into grunts, thoughts into motions… but she never lost consciousness. She was really never less than 100% aware of everything, just in a way that only would have made sense to Noelle and me at that moment, because we were doing our level best to be there with her in it. Of course we weren’t but it all had a logic to it the whole time.

The cliche that the night is darkest just before the dawn was both literally true, given that it was well along through the night, and metaphorically so. Brooke was getting beyond tired, pained, overwhelmed. Now was the time Joy came into talk to us about pain relief options. It was too late, she said, for an epidural, but there were narcotic IV pain relievers they could give her that would allow her to rest and gather up strength between contractions.

Brooke was totally uninterested. She and I had an intense, fragmented conversation about this. I did my best to get her to take the offer, trying to let her know no one would think less of her. I figured, if this midwife, who has been so patient-centered so far, was now advocating for something we had better listen. Even Noelle joined in, letting Brooke know that going back on her earlier commitments would not matter in the long run, and that when she made those commitments, she didn’t, as she could have, known exactly what it would be like.

Brooke didn’t want to. It was stubbornness yes, but it was also because of something more down-to-earth I know about Brooke: pain relief pretty much knocks her out immediately. She was worried it would just make her so loopy and asleep that she wouldn’t be able to continue, and then we’d be on our way to the operating room. Over about 45 minutes, we talked all this over in snatches, bits and pieces, Noelle, me, Brooke, Joy on a couple of occasions. Then finally the topic just sort of went away. I’m still happy with how that went: everyone in the room gave Brooke the space and also their opinion, and she retained decisionmaking ability, and AGENCY, throughout.

If you think that’s just a silly preference on her part, some sort of flaky-liberal aesthetic conceit, some “desire for a birth experience,” I say, you are wrong. That word – AGENCY – and its partner, self-determination – wars have been fought over it. And here was Brooke fighting her own private war to maintain it through one of the most human of all experiences, against a highly leveraged, ready-to-intervene medical establishment that was never more than a few feet away for the 17 hours we were there. Joy kept it at bay for us, as did Noelle, for that matter, as did I, but Brooke fought.

Brooke took no pain relief drugs the entire labor. This in spite of more than 12 hours of Pitocin. I was so proud of her when it was done. It was almost like in addition to remaining pain-relief free, as some sort of dare, she had also undergone the most painful form of labor possible. Most doctors and midwives are under the belief that Pitocin basically necessitates an epidural eventually. That is what Anna had initially told us. As I said before, Brooke had never even really considered it.

By around 3am, somehow, Noelle intuited that things had progressed to a point where we could be getting close. I don’t know how she knew that and I didn’t ask, but she was right. I was texting Becky the whole time as well. I remember the immense relief I felt when Becky told me “this is basically transition.” Transition is a key word – there being four big phases of labor, and transition the third. I think (though I’m still not sure) it’s when the baby’s head finally gets through the mother’s hips and enters the birth canal.

Joy was called in, and she did the first exam since we started: they were trying to put it off as long as possible because of risk of infection. It took 15 seconds; she just felt a little bit and declared, through the again Latinate-Orwellian language of “dilation” and “effacement,” that the baby was almost here. Brooke shouted out “thank you Jesus!” and we moved along the the last phase of labor – in good old Anglo-Saxon – “pushing.”

Brooke had a renewed strength, and actually during this time, they turned down the Pitocin, saying that Brooke’s body was now acting on its own accord. Though, as far as I could tell anyway, the pushing was the most painful part of the labor, the fact that it was the end of the labor meant that didn’t matter.

This was another part that didn’t go the way it goes on TV – i.e., a woman with her legs in stirrups while a doctor “delivers” the baby. “Delivers” belongs in quotes because at best, the Doctor facilitates the delivery. But the dominant image of what happens again actually disguises the woman’s agency, pretends that the doctor is the subject of the sentence – as in “the same doctor delivered all of my babies.” With midwives, without pain relief, this is most definitely not the case. The woman pushes, and works to get the baby into the world.

This pushing, therefore, far from being strictly an exercise in passive waiting while a doctor does some sort of work, was a very active, varying experience. There were times when Brooke’s legs were raised up in the air, but there were other times when she was on her knees, or squatting, or standing. Joy and Noelle worked very closely together (largely without even talking about it) to reposition Brooke. They also worked with a bedsheet, tying it up in knots of different configurations for Brooke to use as leverage. Everything changed every 2-3 minutes, and though it was slow, she did make progress.

Brooke, however, was still modest, at least by some standard. She was very embarrassed and worried about the possibility of either defecation or vomiting. She actually asked the nurse if it was “all right” if she vomited. The nurse, obviously, told her she shouldn’t hold that back. But she was worried about getting the sheets dirty. She actually said that.

All the meters were still beeping, though at some point, they became less worried about the baby’s heartbeat, because the baby was now in a position where it couldn’t really be measured (they were using an externally mounted wireless monitor, not the thing that used to be used, that gets screwed into the baby’s head).

After a few more moments where Brooke started worrying about things that were just absurd to worry about, Joy came into the room and told her, in no uncertain terms, that there was only one way out: “I can tell that you’re very smart, that you’re used to having things very organized and logical in your head, but YOU HAVE GOT TO GET OUT OF YOUR HEAD AND LET THIS HAPPEN or else you’re going to run out of energy and it will end up much harder.”

Brooke really appreciated this, because she knew immediately that it was true. After a bunch more changes of position, coaching, hand-squeezing, and hysteria, and after we could finally see the baby’s head (just a bit of it; it was purplish and looked more like an unshielded brain than a human head), and after they actually re-increased the Pitocin dosage, something decisively changed. I don’t know what it was, but something had clearly gotten much closer to happening.

The reason I knew this was that Joy, who had been in and out for a while, finally came in to stay. She put on new gloves. Lucia, the Spanish-speaking baby nurse from earlier, sat down in her stool by the door and got out some paperwork that she started to fill out. Neither of them said anything, but there was a clear sense of an ending. Like, they had done this before, and this was it. It was happening now.

At 5:36am, the baby’s head got all the way out. The first glimpse I caught of it (I still kept saying “it” for several hours) was its head. Its mouth was still closed (it wasn’t breathing yet), and it was rotating its neck (and therefore its view) back and forth about 90 degrees, from 45 left of 180 to 45 right, evenly and (it seemed to me anyway) calmly. Joy said “hello world!” in a bemused manner – that’s what it looked like it was doing. Like, it was thinking, “oh, no big deal, let’s just get a look around.”

Soon after this, its shoulder popped through, and this caused the baby to lurch forward. Joy caught it. Then in a slow-motion flash, she held it up and said “what do we have dad?” and I responded “it’s a boy.” He was gray and looked like a Klingon (or is it a Romulan, with the peaked head?) They gave me the scissors to cut the cord. Joy placed them in my right hand I switched to my left (I, like Joy also, am left-handed, as I’ve said) and I cut through the cord just moments, nearly instantly after he was there.

Then, Joy held the baby for just a second and he didn’t move, cough, or cry like I thought he was already supposed to be doing. She said “oh, does he need a little love?” It was maybe a one second wait but this was a gap of terrifying length. Everything slowed down and I thought about that statement “does he need a little love?” thinking “oh my god he’s not even alive!” and then, sure enough, time lurched back into full speed, the audio track in my head came back on, he coughed and started crying, and they placed the baby on top of Brooke. Joy said “see, I just need to threaten it, they always come around.”

I sunk down next to Brooke on the bed. Soon after that I collected my thoughts, opened up my phone and texted to my family-only list:

Then an hour passed without any texts from me (though congratulations from Brooke’s mom and then her dad, then eventually her sister and my brother Sam). We sat there, Noelle with us, nurses in and out, but no one bothering us. We were obviously in a state of awe and wonder, looking at this miraculous being now part of our family. We now HAD a family. I mean sure, notionally, before, Brooke and I were a family. But we were really just a “married couple.” Now the word felt right in a way it hadn’t before.

I don’t remember a lot about this time. We were both exhausted (Brooke more than me obviously) and Sam, though he looked a little weird (no one quite tells you the truth, which is that as cute as babies become, newborns aren’t). He seemed to be moving in and out of consciousness, sometimes opening his eyes and looking around, but mostly just sleeping it off.

After that, for a while, the record of my texts is blank. Then about 3 hours later there’s a message – one I sent to our family and our friends (but not the general facebook community) – and it still makes me fight back tears even to look at it:

“So we just had a scare…”

I’ll leave that – truly one of the most trying experiences of my life and I think also Brooke’s – for next time.